ACGME Program Requirements for Graduate Medical Education in Nuclear Medicine - ACGME-approved focused revision: September 27, 2020; effective ...
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ACGME Program Requirements for
Graduate Medical Education
in Nuclear Medicine
ACGME-approved focused revision: September 27, 2020; effective July 1, 2021Contents Introduction .............................................................................................................................. 3 Int.A. Preamble ................................................................................................................. 3 Int.B. Definition of Specialty ............................................................................................ 3 Int.C. Length of Educational Program ............................................................................ 4 I. Oversight ........................................................................................................................... 4 I.A. Sponsoring Institution ........................................................................................... 4 I.B. Participating Sites .................................................................................................. 4 I.C. Recruitment ............................................................................................................ 5 I.D. Resources ............................................................................................................... 6 I.E. Other Learners and Other Care Providers ............................................................ 7 II. Personnel .......................................................................................................................... 7 II.A. Program Director .................................................................................................... 7 II.B. Faculty ...................................................................................................................12 II.C. Program Coordinator ............................................................................................15 II.D. Other Program Personnel .....................................................................................15 III. Resident Appointments ...................................................................................................16 III.A. Eligibility Requirements ........................................................................................16 III.B. Number of Residents ............................................................................................18 III.C. Resident Transfers ................................................................................................18 IV. Educational Program .......................................................................................................18 IV.A. Curriculum Components ......................................................................................18 IV.B. ACGME Competencies..........................................................................................19 IV.C. Curriculum Organization and Resident Experiences..........................................29 IV.D. Scholarship............................................................................................................35 V. Evaluation.........................................................................................................................38 V.A. Resident Evaluation ..............................................................................................38 V.B. Faculty Evaluation.................................................................................................41 V.C. Program Evaluation and Improvement ................................................................42 VI. The Learning and Working Environment .......................................................................46 VI.A. Patient Safety, Quality Improvement, Supervision, and Accountability ............47 VI.B. Professionalism.....................................................................................................53 VI.C. Well-Being..............................................................................................................54 VI.D. Fatigue Mitigation..................................................................................................58 VI.E. Clinical Responsibilities, Teamwork, and Transitions of Care...........................58 VI.F. Clinical Experience and Education ......................................................................60 Nuclear Medicine Tracked Changes Copy ©2020 Accreditation Council for Graduate Medical Education (ACGME) Page 2 of 67
1
2 ACGME Program Requirements for Graduate Medical Education
3 in Nuclear Medicine
4
5 Common Program Requirements (Residency) are in BOLD
6
7 Where applicable, text in italics describes the underlying philosophy of the requirements in that
8 section. These philosophic statements are not program requirements and are therefore not
9 citable.
10
11 Introduction
12
13 Int.A. Graduate medical education is the crucial step of professional
14 development between medical school and autonomous clinical practice. It
15 is in this vital phase of the continuum of medical education that residents
16 learn to provide optimal patient care under the supervision of faculty
17 members who not only instruct, but serve as role models of excellence,
18 compassion, professionalism, and scholarship.
19
20 Graduate medical education transforms medical students into physician
21 scholars who care for the patient, family, and a diverse community; create
22 and integrate new knowledge into practice; and educate future generations
23 of physicians to serve the public. Practice patterns established during
24 graduate medical education persist many years later.
25
26 Graduate medical education has as a core tenet the graded authority and
27 responsibility for patient care. The care of patients is undertaken with
28 appropriate faculty supervision and conditional independence, allowing
29 residents to attain the knowledge, skills, attitudes, and empathy required
30 for autonomous practice. Graduate medical education develops physicians
31 who focus on excellence in delivery of safe, equitable, affordable, quality
32 care; and the health of the populations they serve. Graduate medical
33 education values the strength that a diverse group of physicians brings to
34 medical care.
35
36 Graduate medical education occurs in clinical settings that establish the
37 foundation for practice-based and lifelong learning. The professional
38 development of the physician, begun in medical school, continues through
39 faculty modeling of the effacement of self-interest in a humanistic
40 environment that emphasizes joy in curiosity, problem-solving, academic
41 rigor, and discovery. This transformation is often physically, emotionally,
42 and intellectually demanding and occurs in a variety of clinical learning
43 environments committed to graduate medical education and the well-being
44 of patients, residents, fellows, faculty members, students, and all members
45 of the health care team.
46
47 Int.B. Definition of Specialty
48
49 Nuclear medicine is the medical specialty that uses the Tracer Principle, most
50 often with radiopharmaceuticals, to evaluate molecular, metabolic, physiologic
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52 research.
53
54 Int.C. Length of Educational Program
55
56 The educational program in nuclear medicine must be 36 months in length. (Core)*
57
58 I. Oversight
59
60 I.A. Sponsoring Institution
61
62 The Sponsoring Institution is the organization or entity that assumes the
63 ultimate financial and academic responsibility for a program of graduate
64 medical education, consistent with the ACGME Institutional Requirements.
65
66 When the Sponsoring Institution is not a rotation site for the program, the
67 most commonly utilized site of clinical activity for the program is the
68 primary clinical site.
69
Background and Intent: Participating sites will reflect the health care needs of the
community and the educational needs of the residents. A wide variety of organizations
may provide a robust educational experience and, thus, Sponsoring Institutions and
participating sites may encompass inpatient and outpatient settings including, but not
limited to a university, a medical school, a teaching hospital, a nursing home, a school
of public health, a health department, a public health agency, an organized health care
delivery system, a medical examiner’s office, an educational consortium, a teaching
health center, a physician group practice, federally qualified health center, or an
educational foundation.
70
71 I.A.1. The program must be sponsored by one ACGME-accredited
72 Sponsoring Institution. (Core)*
73
74 I.B. Participating Sites
75
76 A participating site is an organization providing educational experiences or
77 educational assignments/rotations for residents.
78
79 I.B.1. The program, with approval of its Sponsoring Institution, must
80 designate a primary clinical site. (Core)
81
82 I.B.1.a) The program must be based at the primary clinical site. (Core)
83
84 I.B.1.a).(1) A program using multiple sites must ensure a unified
85 educational experience for the residents. (Core)
86
87 I.B.1.b) Each participating site must offer significant educational
88 opportunities to the overall program. (Core)
89
90 I.B.1.c) Programs should avoid affiliations with sites at such distances
91 from the primary clinical site as to make resident attendance at
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93 educational experience at a participating site. (Core Detail)
94
95 I.B.2. There must be a program letter of agreement (PLA) between the
96 program and each participating site that governs the relationship
97 between the program and the participating site providing a required
98 assignment. (Core)
99
100 I.B.2.a) The PLA must:
101
102 I.B.2.a).(1) be renewed at least every 10 years; and, (Core)
103
104 I.B.2.a).(2) be approved by the designated institutional official
105 (DIO). (Core)
106
107 I.B.3. The program must monitor the clinical learning and working
108 environment at all participating sites. (Core)
109
110 I.B.3.a) At each participating site there must be one faculty member,
111 designated by the program director as the site director, who
112 is accountable for resident education at that site, in
113 collaboration with the program director. (Core)
114
Background and Intent: While all residency programs must be sponsored by a single
ACGME-accredited Sponsoring Institution, many programs will utilize other clinical
settings to provide required or elective training experiences. At times it is appropriate
to utilize community sites that are not owned by or affiliated with the Sponsoring
Institution. Some of these sites may be remote for geographic, transportation, or
communication issues. When utilizing such sites the program must ensure the quality
of the educational experience. The requirements under I.B.3. are intended to ensure
that this will be the case.
Suggested elements to be considered in PLAs will be found in the ACGME Program
Director’s Guide to the Common Program Requirements. These include:
• Identifying the faculty members who will assume educational and supervisory
responsibility for residents
• Specifying the responsibilities for teaching, supervision, and formal evaluation
of residents
• Specifying the duration and content of the educational experience
• Stating the policies and procedures that will govern resident education during
the assignment
115
116 I.B.4. The program director must submit any additions or deletions of
117 participating sites routinely providing an educational experience,
118 required for all residents, of one month full time equivalent (FTE) or
119 more through the ACGME’s Accreditation Data System (ADS). (Core)
120
121 I.C. The program, in partnership with its Sponsoring Institution, must engage in
122 practices that focus on mission-driven, ongoing, systematic recruitment
123 and retention of a diverse and inclusive workforce of residents, fellows (if
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125 relevant members of its academic community. (Core)
126
Background and Intent: It is expected that the Sponsoring Institution has, and
programs implement, policies and procedures related to recruitment and retention of
minorities underrepresented in medicine and medical leadership in accordance with
the Sponsoring Institution’s mission and aims. The program’s annual evaluation must
include an assessment of the program’s efforts to recruit and retain a diverse
workforce, as noted in V.C.1.c).(5).(c).
127
128 I.D. Resources
129
130 I.D.1. The program, in partnership with its Sponsoring Institution, must
131 ensure the availability of adequate resources for resident education.
(Core)
132
133
134 I.D.1.a) There must be Internet access for resident educational use. (Core
Detail)
135
136
137 I.D.2. The program, in partnership with its Sponsoring Institution, must
138 ensure healthy and safe learning and working environments that
139 promote resident well-being and provide for: (Core)
140
141 I.D.2.a) access to food while on duty; (Core)
142
143 I.D.2.b) safe, quiet, clean, and private sleep/rest facilities available
144 and accessible for residents with proximity appropriate for
145 safe patient care; (Core)
146
Background and Intent: Care of patients within a hospital or health system occurs
continually through the day and night. Such care requires that residents function at
their peak abilities, which requires the work environment to provide them with the
ability to meet their basic needs within proximity of their clinical responsibilities.
Access to food and rest are examples of these basic needs, which must be met while
residents are working. Residents should have access to refrigeration where food may
be stored. Food should be available when residents are required to be in the hospital
overnight. Rest facilities are necessary, even when overnight call is not required, to
accommodate the fatigued resident.
147
148 I.D.2.c) clean and private facilities for lactation that have refrigeration
149 capabilities, with proximity appropriate for safe patient care;
(Core)
150
151
Background and Intent: Sites must provide private and clean locations where residents
may lactate and store the milk within a refrigerator. These locations should be in close
proximity to clinical responsibilities. It would be helpful to have additional support
within these locations that may assist the resident with the continued care of patients,
such as a computer and a phone. While space is important, the time required for
lactation is also critical for the well-being of the resident and the resident's family, as
outlined in VI.C.1.d).(1).
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153 I.D.2.d) security and safety measures appropriate to the participating
154 site; and, (Core)
155
156 I.D.2.e) accommodations for residents with disabilities consistent
157 with the Sponsoring Institution’s policy. (Core)
158
159 I.D.3. Residents must have ready access to specialty-specific and other
160 appropriate reference material in print or electronic format. This
161 must include access to electronic medical literature databases with
162 full text capabilities. (Core)
163
164 I.D.4. The program’s educational and clinical resources must be adequate
165 to support the number of residents appointed to the program. (Core)
166
167 I.D.4.a) There must be a volume and variety of patients to ensure that
168 residents gain experience in the full range of nuclear
169 medicine/molecular imaging procedures and interpretations. (Core)
170
171 I.E. The presence of other learners and other care providers, including, but not
172 limited to, residents from other programs, subspecialty fellows, and
173 advanced practice providers, must enrich the appointed residents’
174 education. (Core)
175
176 I.E.1. The program must report circumstances when the presence of other
177 learners has interfered with the residents’ education to the DIO and
178 Graduate Medical Education Committee (GMEC). (Core)
179
Background and Intent: The clinical learning environment has become increasingly
complex and often includes care providers, students, and post-graduate residents and
fellows from multiple disciplines. The presence of these practitioners and their
learners enriches the learning environment. Programs have a responsibility to monitor
the learning environment to ensure that residents’ education is not compromised by
the presence of other providers and learners.
180
181 II. Personnel
182
183 II.A. Program Director
184
185 II.A.1. There must be one faculty member appointed as program director
186 with authority and accountability for the overall program, including
187 compliance with all applicable program requirements. (Core)
188
189 II.A.1.a) The Sponsoring Institution’s GMEC must approve a change in
190 program director. (Core)
191
192 II.A.1.b) Final approval of the program director resides with the
193 Review Committee. (Core)
194
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©2020 Accreditation Council for Graduate Medical Education (ACGME) Page 7 of 67Background and Intent: While the ACGME recognizes the value of input from
numerous individuals in the management of a residency, a single individual must be
designated as program director and made responsible for the program. This
individual will have dedicated time for the leadership of the residency, and it is this
individual’s responsibility to communicate with the residents, faculty members, DIO,
GMEC, and the ACGME. The program director’s nomination is reviewed and approved
by the GMEC. Final approval of program directors resides with the Review Committee.
195
196 II.A.1.c) The program must demonstrate retention of the program
197 director for a length of time adequate to maintain continuity
198 of leadership and program stability. (Core)
199
200 II.A.1.c).(1) The program director should serve in this position for a
201 minimum of five years. (Detail)
202
Background and Intent: The success of residency programs is generally enhanced by
continuity in the program director position. The professional activities required of a
program director are unique and complex and take time to master. All programs are
encouraged to undertake succession planning to facilitate program stability when
there is necessary turnover in the program director position.
203
204 II.A.2. At a minimum, the program director must be provided with the
205 salary support required to devote 20 percent FTE of non-clinical
206 time to the administration of the program. (Core)
207
Background and Intent: Twenty percent FTE is defined as one day per week.
“Administrative time” is defined as non-clinical time spent meeting the responsibilities
of the program director as detailed in requirements II.A.4.-II.A.4.a).(16).
The requirement does not address the source of funding required to provide the
specified salary support.
208
209 II.A.3. Qualifications of the program director:
210
211 II.A.3.a) must include specialty expertise and at least three years of
212 documented educational and/or administrative experience, or
213 qualifications acceptable to the Review Committee; (Core)
214
Background and Intent: Leading a program requires knowledge and skills that are
established during residency and subsequently further developed. The time period
from completion of residency until assuming the role of program director allows the
individual to cultivate leadership abilities while becoming professionally established.
The three-year period is intended for the individual's professional maturation.
The broad allowance for educational and/or administrative experience recognizes that
strong leaders arise through diverse pathways. These areas of expertise are important
when identifying and appointing a program director. The choice of a program director
should be informed by the mission of the program and the needs of the community.
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©2020 Accreditation Council for Graduate Medical Education (ACGME) Page 8 of 67In certain circumstances, the program and Sponsoring Institution may propose and the
Review Committee may accept a candidate for program director who fulfills these
goals but does not meet the three-year minimum.
215
216 II.A.3.b) must include current certification in the specialty for which
217 they are the program director by the American Board of
218 Nuclear Medicine or by the American Osteopathic Board of
219 Nuclear Medicine, or specialty qualifications that are
220 acceptable to the Review Committee; (Core)
221
222 II.A.3.b).(1) Other acceptable qualifications are certification by the
223 American Board of Radiology with subspecialty certification
224 in Nuclear Radiology. (Core)
225
226 II.A.3.b).(2) The program director should actively participate in
227 Maintenance of Certification. (Core)
228
229 II.A.3.c) must include current medical licensure and appropriate
230 medical staff appointment; (Core)
231
232 II.A.3.d) must include ongoing clinical activity; (Core)
233
234 II.A.3.e) must include being an authorized user for 10CFR 35.190, 290,
235 and 390, including 392, 394, and 396; (Core)
236
237 II.A.3.f) must include full-time appointment; and, (Core)
238
239 II.A.3.g) must include broad knowledge of, experience with, and
240 commitment to general nuclear medicine/molecular imaging. (Core)
241
Background and Intent: A program director is a role model for faculty members and
residents. The program director must participate in clinical activity consistent with the
specialty. This activity will allow the program director to role model the Core
Competencies for the faculty members and residents.
242
243 II.A.4. Program Director Responsibilities
244
245 The program director must have responsibility, authority, and
246 accountability for: administration and operations; teaching and
247 scholarly activity; resident recruitment and selection, evaluation,
248 and promotion of residents, and disciplinary action; supervision of
249 residents; and resident education in the context of patient care. (Core)
250
251 II.A.4.a) The program director must:
252
253 II.A.4.a).(1) be a role model of professionalism; (Core)
254
Background and Intent: The program director, as the leader of the program, must
serve as a role model to residents in addition to fulfilling the technical aspects of the
role. As residents are expected to demonstrate compassion, integrity, and respect for
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utmost importance, therefore, that the program director model outstanding
professionalism, high quality patient care, educational excellence, and a scholarly
approach to work. The program director creates an environment where respectful
discussion is welcome, with the goal of continued improvement of the educational
experience.
255
256 II.A.4.a).(2) design and conduct the program in a fashion
257 consistent with the needs of the community, the
258 mission(s) of the Sponsoring Institution, and the
259 mission(s) of the program; (Core)
260
Background and Intent: The mission of institutions participating in graduate medical
education is to improve the health of the public. Each community has health needs that
vary based upon location and demographics. Programs must understand the social
determinants of health of the populations they serve and incorporate them in the
design and implementation of the program curriculum, with the ultimate goal of
addressing these needs and health disparities.
261
262 II.A.4.a).(3) administer and maintain a learning environment
263 conducive to educating the residents in each of the
264 ACGME Competency domains; (Core)
265
Background and Intent: The program director may establish a leadership team to
assist in the accomplishment of program goals. Residency programs can be highly
complex. In a complex organization, the leader typically has the ability to delegate
authority to others, yet remains accountable. The leadership team may include
physician and non-physician personnel with varying levels of education, training, and
experience.
266
267 II.A.4.a).(4) develop and oversee a process to evaluate candidates
268 prior to approval as program faculty members for
269 participation in the residency program education and
270 at least annually thereafter, as outlined in V.B.; (Core)
271
272 II.A.4.a).(5) have the authority to approve program faculty
273 members for participation in the residency program
274 education at all sites; (Core)
275
276 II.A.4.a).(6) have the authority to remove program faculty
277 members from participation in the residency program
278 education at all sites; (Core)
279
280 II.A.4.a).(7) have the authority to remove residents from
281 supervising interactions and/or learning environments
282 that do not meet the standards of the program; (Core)
283
Background and Intent: The program director has the responsibility to ensure that all
who educate residents effectively role model the Core Competencies. Working with a
resident is a privilege that is earned through effective teaching and professional role
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of the clinical learning environment are not met.
There may be faculty in a department who are not part of the educational program, and
the program director controls who is teaching the residents.
284
285 II.A.4.a).(8) submit accurate and complete information required
286 and requested by the DIO, GMEC, and ACGME; (Core)
287
288 II.A.4.a).(9) provide applicants who are offered an interview with
289 information related to the applicant’s eligibility for the
290 relevant specialty board examination(s); (Core)
291
292 II.A.4.a).(10) provide a learning and working environment in which
293 residents have the opportunity to raise concerns and
294 provide feedback in a confidential manner as
295 appropriate, without fear of intimidation or retaliation;
(Core)
296
297
298 II.A.4.a).(11) ensure the program’s compliance with the Sponsoring
299 Institution’s policies and procedures related to
300 grievances and due process; (Core)
301
302 II.A.4.a).(12) ensure the program’s compliance with the Sponsoring
303 Institution’s policies and procedures for due process
304 when action is taken to suspend or dismiss, not to
305 promote, or not to renew the appointment of a
306 resident; (Core)
307
Background and Intent: A program does not operate independently of its Sponsoring
Institution. It is expected that the program director will be aware of the Sponsoring
Institution’s policies and procedures, and will ensure they are followed by the
program’s leadership, faculty members, support personnel, and residents.
308
309 II.A.4.a).(13) ensure the program’s compliance with the Sponsoring
310 Institution’s policies and procedures on employment
311 and non-discrimination; (Core)
312
313 II.A.4.a).(13).(a) Residents must not be required to sign a non-
314 competition guarantee or restrictive covenant.
(Core)
315
316
317 II.A.4.a).(14) document verification of program completion for all
318 graduating residents within 30 days; (Core)
319
320 II.A.4.a).(15) provide verification of an individual resident’s
321 completion upon the resident’s request, within 30
322 days; and, (Core)
323
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©2020 Accreditation Council for Graduate Medical Education (ACGME) Page 11 of 67Background and Intent: Primary verification of graduate medical education is
important to credentialing of physicians for further training and practice. Such
verification must be accurate and timely. Sponsoring Institution and program policies
for record retention are important to facilitate timely documentation of residents who
have previously completed the program. Residents who leave the program prior to
completion also require timely documentation of their summative evaluation.
324
325 II.A.4.a).(16) obtain review and approval of the Sponsoring
326 Institution’s DIO before submitting information or
327 requests to the ACGME, as required in the Institutional
328 Requirements and outlined in the ACGME Program
329 Director’s Guide to the Common Program
330 Requirements. (Core)
331
332 II.B. Faculty
333
334 Faculty members are a foundational element of graduate medical education
335 – faculty members teach residents how to care for patients. Faculty
336 members provide an important bridge allowing residents to grow and
337 become practice-ready, ensuring that patients receive the highest quality of
338 care. They are role models for future generations of physicians by
339 demonstrating compassion, commitment to excellence in teaching and
340 patient care, professionalism, and a dedication to lifelong learning. Faculty
341 members experience the pride and joy of fostering the growth and
342 development of future colleagues. The care they provide is enhanced by
343 the opportunity to teach. By employing a scholarly approach to patient
344 care, faculty members, through the graduate medical education system,
345 improve the health of the individual and the population.
346
347 Faculty members ensure that patients receive the level of care expected
348 from a specialist in the field. They recognize and respond to the needs of
349 the patients, residents, community, and institution. Faculty members
350 provide appropriate levels of supervision to promote patient safety. Faculty
351 members create an effective learning environment by acting in a
352 professional manner and attending to the well-being of the residents and
353 themselves.
354
Background and Intent: “Faculty” refers to the entire teaching force responsible for
educating residents. The term “faculty,” including “core faculty,” does not imply or
require an academic appointment or salary support.
355
356 II.B.1. At each participating site, there must be a sufficient number of
357 faculty members with competence to instruct and supervise all
358 residents at that location. (Core)
359
360 II.B.2. Faculty members must:
361
362 II.B.2.a) be role models of professionalism; (Core)
363
364 II.B.2.b) demonstrate commitment to the delivery of safe, quality,
365 cost-effective, patient-centered care; (Core)
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Background and Intent: Patients have the right to expect quality, cost-effective care
with patient safety at its core. The foundation for meeting this expectation is formed
during residency and fellowship. Faculty members model these goals and continually
strive for improvement in care and cost, embracing a commitment to the patient and
the community they serve.
367
368 II.B.2.c) demonstrate a strong interest in the education of residents;
(Core)
369
370
371 II.B.2.d) devote sufficient time to the educational program to fulfill
372 their supervisory and teaching responsibilities; (Core)
373
374 II.B.2.e) administer and maintain an educational environment
375 conducive to educating residents; (Core)
376
377 II.B.2.f) regularly participate in organized clinical discussions,
378 rounds, journal clubs, and conferences; and, (Core)
379
380 II.B.2.g) pursue faculty development designed to enhance their skills
381 at least annually: (Core)
382
Background and Intent: Faculty development is intended to describe structured
programming developed for the purpose of enhancing transference of knowledge,
skill, and behavior from the educator to the learner. Faculty development may occur
in a variety of configurations (lecture, workshop, etc.) using internal and/or external
resources. Programming is typically needs-based (individual or group) and may be
specific to the institution or the program. Faculty development programming is to be
reported for the residency program faculty in the aggregate.
383
384 II.B.2.g).(1) as educators; (Core)
385
386 II.B.2.g).(2) in quality improvement and patient safety; (Core)
387
388 II.B.2.g).(3) in fostering their own and their residents’ well-being;
389 and, (Core)
390
391 II.B.2.g).(4) in patient care based on their practice-based learning
392 and improvement efforts. (Core)
393
Background and Intent: Practice-based learning serves as the foundation for the
practice of medicine. Through a systematic analysis of one’s practice and review of the
literature, one is able to make adjustments that improve patient outcomes and care.
Thoughtful consideration to practice-based analysis improves quality of care, as well
as patient safety. This allows faculty members to serve as role models for residents in
practice-based learning.
394
395 II.B.3. Faculty Qualifications
396
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©2020 Accreditation Council for Graduate Medical Education (ACGME) Page 13 of 67397 II.B.3.a) Faculty members must have appropriate qualifications in
398 their field and hold appropriate institutional appointments.
(Core)
399
400
401 II.B.3.b) Physician faculty members must:
402
403 II.B.3.b).(1) have current certification in the specialty by the
404 American Board of Nuclear Medicine or the American
405 Osteopathic Board of Nuclear Medicine, or possess
406 qualifications judged acceptable to the Review
407 Committee; or, (Core)
408
409 II.B.3.b).(2) have current certification in nuclear radiology by the
410 American Board of Radiology. (Core)
411
412 II.B.3.b).(2).(a) In programs affiliated with a medical school, all
413 physician faculty members must have an academic
414 appointment. (Core Detail)
415
416 II.B.3.c) Any non-physician faculty members who participate in
417 residency program education must be approved by the
418 program director. (Core)
419
Background and Intent: The provision of optimal and safe patient care requires a team
approach. The education of residents by non-physician educators enables the
resident to better manage patient care and provides valuable advancement of the
residents’ knowledge. Furthermore, other individuals contribute to the education of
the resident in the basic science of the specialty or in research methodology. If the
program director determines that the contribution of a non-physician individual is
significant to the education of the residents, the program director may designate the
individual as a program faculty member or a program core faculty member.
420
421 II.B.4. Core Faculty
422
423 Core faculty members must have a significant role in the education
424 and supervision of residents and must devote a significant portion
425 of their entire effort to resident education and/or administration, and
426 must, as a component of their activities, teach, evaluate, and
427 provide formative feedback to residents. (Core)
428
Background and Intent: Core faculty members are critical to the success of resident
education. They support the program leadership in developing, implementing, and
assessing curriculum and in assessing residents’ progress toward achievement of
competence in the specialty. Core faculty members should be selected for their broad
knowledge of and involvement in the program, permitting them to effectively evaluate
the program, including completion of the annual ACGME Faculty Survey.
429
430 II.B.4.a) Core faculty members must be designated by the program
431 director. (Core)
432
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434 Faculty Survey. (Core)
435
436 II.B.4.c) There must be at least one core physician faculty member in
437 addition to the program director. (Core)
438
439 II.B.4.c).(1) Programs must maintain a ratio of at least one core
440 physician faculty member per every two residents. (Core)
441
442 II.C. Program Coordinator
443
444 II.C.1. There must be a program coordinator. (Core)
445
446 II.C.2. At a minimum, the program coordinator must be supported at 50
447 percent FTE for the administration of the program. (Core)
448
Background and Intent: Fifty percent FTE is defined as two-and-a-half (2.5) days per
week.
The requirement does not address the source of funding required to provide the
specified salary support.
Each program requires a lead administrative person, frequently referred to as a
program coordinator, administrator, or as titled by the institution. This person will
frequently manage the day-to-day operations of the program and serve as an important
liaison with learners, faculty and other staff members, and the ACGME. Individuals
serving in this role are recognized as program coordinators by the ACGME.
The program coordinator is a member of the leadership team and is critical to the
success of the program. As such, the program coordinator must possess skills in
leadership and personnel management. Program coordinators are expected to develop
unique knowledge of the ACGME and Program Requirements, policies, and
procedures. Program coordinators assist the program director in accreditation efforts,
educational programming, and support of residents.
Programs, in partnership with their Sponsoring Institutions, should encourage the
professional development of their program coordinators and avail them of
opportunities for both professional and personal growth. Programs with fewer
residents may not require a full-time coordinator; one coordinator may support more
than one program.
449
450 II.D. Other Program Personnel
451
452 The program, in partnership with its Sponsoring Institution, must jointly
453 ensure the availability of necessary personnel for the effective
454 administration of the program. (Core)
455
Background and Intent: Multiple personnel may be required to effectively administer a
program. These may include staff members with clerical skills, project managers,
education experts, and staff members to maintain electronic communication for the
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discipline.
456
457 III. Resident Appointments
458
459 III.A. Eligibility Requirements
460
461 III.A.1. An applicant must meet one of the following qualifications to be
462 eligible for appointment to an ACGME-accredited program: (Core)
463
464 III.A.1.a) graduation from a medical school in the United States or
465 Canada, accredited by the Liaison Committee on Medical
466 Education (LCME) or graduation from a college of
467 osteopathic medicine in the United States, accredited by the
468 American Osteopathic Association Commission on
469 Osteopathic College Accreditation (AOACOCA); or, (Core)
470
471 III.A.1.b) graduation from a medical school outside of the United
472 States or Canada, and meeting one of the following additional
473 qualifications: (Core)
474
475 III.A.1.b).(1) holding a currently valid certificate from the
476 Educational Commission for Foreign Medical
477 Graduates (ECFMG) prior to appointment; or, (Core)
478
479 III.A.1.b).(2) holding a full and unrestricted license to practice
480 medicine in the United States licensing jurisdiction in
481 which the ACGME-accredited program is located. (Core)
482
483 III.A.2. All prerequisite post-graduate clinical education required for initial
484 entry or transfer into ACGME-accredited residency programs must
485 be completed in ACGME-accredited residency programs, AOA-
486 approved residency programs, Royal College of Physicians and
487 Surgeons of Canada (RCPSC)-accredited or College of Family
488 Physicians of Canada (CFPC)-accredited residency programs
489 located in Canada, or in residency programs with ACGME
490 International (ACGME-I) Advanced Specialty Accreditation. (Core)
491
492 III.A.2.a) Residency programs must receive verification of each
493 resident’s level of competency in the required clinical field
494 using ACGME, CanMEDS, or ACGME-I Milestones evaluations
495 from the prior training program upon matriculation. (Core)
496
497 III.A.2.a).(1) To be eligible for appointment to the program at the NM1
498 level, residents must have satisfactorily completed one
499 year of graduate medical education in a program that
500 satisfies the requirements in III.A.2. (Core)
501
502 III.A.2.a).(1).(a) This year must include a minimum of nine months
503 of direct patient care. (Core)
504
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506 level, residents must have satisfactorily completed a
507 program that satisfies the requirements in III.A.2. (Core)
508
509 III.A.2.a).(2).(a) The educational program for these residents must
510 be 24 months in length. (Core)
511
512 III.A.2.a).(3) To be eligible for appointment to the program at the NM3
513 level, residents must have satisfactorily completed a
514 program in diagnostic radiology that satisfies the
515 requirements in III.A.2. (Core)
516
517 III.A.2.a).(3).(a) The educational program for these residents must
518 be 12 months in length. (Core)
519
Background and Intent: Programs with ACGME-I Foundational Accreditation or from
institutions with ACGME-I accreditation do not qualify unless the program has also
achieved ACGME-I Advanced Specialty Accreditation. To ensure entrants into ACGME-
accredited programs from ACGME-I programs have attained the prerequisite
milestones for this training, they must be from programs that have ACGME-I Advanced
Specialty Accreditation.
520
521 III.A.3. A physician who has completed a residency program that was not
522 accredited by ACGME, AOA, RCPSC, CFPC, or ACGME-I (with
523 Advanced Specialty Accreditation) may enter an ACGME-accredited
524 residency program in the same specialty at the PGY-1 level and, at
525 the discretion of the program director of the ACGME-accredited
526 program and with approval by the GMEC, may be advanced to the
527 PGY-2 level based on ACGME Milestones evaluations at the ACGME-
528 accredited program. This provision applies only to entry into
529 residency in those specialties for which an initial clinical year is not
530 required for entry. (Core)
531
532 III.A.4. Resident Eligibility Exception
533
534 The Review Committee for Nuclear Medicine will allow the following
535 exception to the resident eligibility requirements (for residents
536 entering the program via III.A.2.a).(2) and III.A.2.a).(3)): (Core)
537
538 III.A.4.a) An ACGME-accredited residency program may accept an
539 exceptionally qualified international graduate applicant who
540 does not satisfy the eligibility requirements listed in III.A.1.-
541 III.A.3., but who does meet all of the following additional
542 qualifications and conditions: (Core)
543
544 III.A.4.a).(1) evaluation by the program director and residency
545 selection committee of the applicant’s suitability to
546 enter the program, based on prior training and review
547 of the summative evaluations of this training; and, (Core)
548
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550 qualifications by the GMEC; and, (Core)
551
552 III.A.4.a).(3) verification of Educational Commission for Foreign
553 Medical Graduates (ECFMG) certification. (Core)
554
555 III.A.4.b) Applicants accepted through this exception must have an
556 evaluation of their performance by the Clinical Competency
557 Committee within 12 weeks of matriculation. (Core)
558
559 III.B. The program director must not appoint more residents than approved by
560 the Review Committee. (Core)
561
562 III.B.1. All complement increases must be approved by the Review
563 Committee. (Core)
564
565 III.C. Resident Transfers
566
567 The program must obtain verification of previous educational experiences
568 and a summative competency-based performance evaluation prior to
569 acceptance of a transferring resident, and Milestones evaluations upon
570 matriculation. (Core)
571
572 IV. Educational Program
573
574 The ACGME accreditation system is designed to encourage excellence and
575 innovation in graduate medical education regardless of the organizational
576 affiliation, size, or location of the program.
577
578 The educational program must support the development of knowledgeable, skillful
579 physicians who provide compassionate care.
580
581 In addition, the program is expected to define its specific program aims consistent
582 with the overall mission of its Sponsoring Institution, the needs of the community
583 it serves and that its graduates will serve, and the distinctive capabilities of
584 physicians it intends to graduate. While programs must demonstrate substantial
585 compliance with the Common and specialty-specific Program Requirements, it is
586 recognized that within this framework, programs may place different emphasis on
587 research, leadership, public health, etc. It is expected that the program aims will
588 reflect the nuanced program-specific goals for it and its graduates; for example, it
589 is expected that a program aiming to prepare physician-scientists will have a
590 different curriculum from one focusing on community health.
591
592 IV.A. The curriculum must contain the following educational components: (Core)
593
594 IV.A.1. a set of program aims consistent with the Sponsoring Institution’s
595 mission, the needs of the community it serves, and the desired
596 distinctive capabilities of its graduates; (Core)
597
598 IV.A.1.a) The program’s aims must be made available to program
599 applicants, residents, and faculty members. (Core)
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601 IV.A.2. competency-based goals and objectives for each educational
602 experience designed to promote progress on a trajectory to
603 autonomous practice. These must be distributed, reviewed, and
604 available to residents and faculty members; (Core)
605
Background and Intent: The trajectory to autonomous practice is documented by
Milestones evaluation. The Milestones detail the progress of a resident in attaining
skill in each competency domain. They are developed by each specialty group and
allow evaluation based on observable behaviors. Milestones are considered formative
and should be used to identify learning needs. This may lead to focused or general
curricular revision in any given program or to individualized learning plans for any
specific resident.
606
607 IV.A.3. delineation of resident responsibilities for patient care, progressive
608 responsibility for patient management, and graded supervision; (Core)
609
Background and Intent: These responsibilities may generally be described by PGY
level and specifically by Milestones progress as determined by the Clinical
Competency Committee. This approach encourages the transition to competency-
based education. An advanced learner may be granted more responsibility
independent of PGY level and a learner needing more time to accomplish a certain
task may do so in a focused rather than global manner.
610
611 IV.A.4. a broad range of structured didactic activities; (Core)
612
613 IV.A.4.a) Residents must be provided with protected time to participate
614 in core didactic activities. (Core)
615
Background and Intent: It is intended that residents will participate in structured
didactic activities. It is recognized that there may be circumstances in which this is
not possible. Programs should define core didactic activities for which time is
protected and the circumstances in which residents may be excused from these
didactic activities. Didactic activities may include, but are not limited to, lectures,
conferences, courses, labs, asynchronous learning, simulations, drills, case
discussions, grand rounds, didactic teaching, and education in critical appraisal of
medical evidence.
616
617 IV.A.5. advancement of residents’ knowledge of ethical principles
618 foundational to medical professionalism; and, (Core)
619
620 IV.A.6. advancement in the residents’ knowledge of the basic principles of
621 scientific inquiry, including how research is designed, conducted,
622 evaluated, explained to patients, and applied to patient care. (Core)
623
624 IV.B. ACGME Competencies
625
Background and Intent: The Competencies provide a conceptual framework
describing the required domains for a trusted physician to enter autonomous
practice. These Competencies are core to the practice of all physicians, although the
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of the Competencies are articulated through the Milestones for each specialty.
626
627 IV.B.1. The program must integrate the following ACGME Competencies
628 into the curriculum: (Core)
629
630 IV.B.1.a) Professionalism
631
632 Residents must demonstrate a commitment to
633 professionalism and an adherence to ethical principles. (Core)
634
635 IV.B.1.a).(1) Residents must demonstrate competence in:
636
637 IV.B.1.a).(1).(a) compassion, integrity, and respect for others;
(Core)
638
639
640 IV.B.1.a).(1).(b) responsiveness to patient needs that
641 supersedes self-interest; (Core)
642
Background and Intent: This includes the recognition that under certain
circumstances, the interests of the patient may be best served by transitioning care to
another provider. Examples include fatigue, conflict or duality of interest, not
connecting well with a patient, or when another physician would be better for the
situation based on skill set or knowledge base.
643
644 IV.B.1.a).(1).(c) respect for patient privacy and autonomy; (Core)
645
646 IV.B.1.a).(1).(d) accountability to patients, society, and the
647 profession; (Core)
648
649 IV.B.1.a).(1).(e) respect and responsiveness to diverse patient
650 populations, including but not limited to
651 diversity in gender, age, culture, race, religion,
652 disabilities, national origin, socioeconomic
653 status, and sexual orientation; (Core)
654
655 IV.B.1.a).(1).(f) ability to recognize and develop a plan for one’s
656 own personal and professional well-being; and,
(Core)
657
658
659 IV.B.1.a).(1).(g) appropriately disclosing and addressing
660 conflict or duality of interest. (Core)
661
662 IV.B.1.b) Patient Care and Procedural Skills
663
Background and Intent: Quality patient care is safe, effective, timely, efficient, patient-
centered, equitable, and designed to improve population health, while reducing per
capita costs. (See the Institute of Medicine [IOM]’s Crossing the Quality Chasm: A
New Health System for the 21st Century, 2001 and Berwick D, Nolan T, Whittington J.
The Triple Aim: care, cost, and quality. Health Affairs. 2008; 27(3):759-769.). In
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to improve patient care and reduce burnout among residents, fellows, and practicing
physicians.
These organizing principles inform the Common Program Requirements across all
Competency domains. Specific content is determined by the Review Committees with
input from the appropriate professional societies, certifying boards, and the
community.
664
665 IV.B.1.b).(1) Residents must be able to provide patient care that is
666 compassionate, appropriate, and effective for the
667 treatment of health problems and the promotion of
668 health. (Core)
669
670 IV.B.1.b).(1).(a) Residents must demonstrate competence in:
671
672 IV.B.1.b).(1).(a).(i) patient evaluation to include: pertinent
673 patient information relevant to the requested
674 procedure using patient interview; chart and
675 computer data base review; the
676 performance of a focused physical
677 examination as indicated; and
678 communication with the referring physician;
(Core)
679
680
681 IV.B.1.b).(1).(a).(ii) selection, performance, and interpretation of
682 appropriate:
683
684 IV.B.1.b).(1).(a).(ii).(a) musculoskeletal studies, including
685 bone mineral density
686 measurements, for malignant and
687 benign disease, (Core)
688
689 IV.B.1.b).(1).(a).(ii).(b) myocardial perfusion imaging with
690 treadmill and pharmacologic stress,
691 including patient monitoring, with
692 emphasis on electrocardiographic
693 interpretation; (Core)
694
695 IV.B.1.b).(1).(a).(ii).(c) electrocardiogram (ECG)-gated
696 ventriculography for evaluation of
697 ventricular performance; (Core)
698
699 IV.B.1.b).(1).(a).(ii).(d) endocrinologic studies, including
700 studies of the thyroid and
701 parathyroid; (Core)
702
703 IV.B.1.b).(1).(a).(ii).(d).(i) When appropriate, thyroid
704 studies must include
705 measurement of iodine
706 uptake and dosimetry
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708 therapy. (Core)
709
710 IV.B.1.b).(1).(a).(ii).(e) gastrointestinal studies, including
711 transit studies, and studies of the
712 liver and hepatobiliary system, of
713 bleeding, and of Meckel’s
714 diverticulum; (Core)
715
716 IV.B.1.b).(1).(a).(ii).(f) infection studies, including such as
717 studies of gallium citrate, of FDG
718 PET, labeled leukocytes, and of
719 bone marrow; (Core)
720
721 IV.B.1.b).(1).(a).(ii).(g) neurologic studies, including studies
722 of cerebral perfusion, cerebral
723 metabolism, and cerebrospinal fluid,
724 including studies of dementia,
725 epilepsy, and brain death; (Core)
726
727 IV.B.1.b).(1).(a).(ii).(h) oncologic studies, including studies
728 of sentinel node localization,
729 fluorodeoxyglucose (FDG), Meta-
730 Iodo-Benzyl-Guanidine (MIBG),
731 somatostatin-receptor imaging, and
732 other agents as they become
733 available; (Core)
734
735 IV.B.1.b).(1).(a).(ii).(i) pulmonary studies, including studies
736 of perfusion and ventilation for
737 pulmonary embolus, right-to-left
738 shunts, and quantitative assessment
739 of perfusion and ventilation; (Core)
740
741 IV.B.1.b).(1).(a).(ii).(j) urinary tract studies, including
742 studies of renal perfusion, function
743 and cortical imaging, and renal
744 scintigraphy with pharmacologic
745 interventions and, (Core)
746
747 IV.B.1.b).(1).(a).(ii).(k) PET, PET/CT, and other hybrid
748 molecular imaging studies for both
749 oncologic and non-oncologic
750 indications; (Core)
751
752 IV.B.1.b).(1).(a).(ii).(l) cross-sectional imaging of the brain,
753 head and neck, thorax, abdomen,
754 and pelvis with CT in the context of
755 SPECT/CT and PET/CT; (Core)
756
757 IV.B.1.b).(1).(a).(ii).(m) therapeutic administration of
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